Tariff intervention: yes, but …

mediX Zurich welcomes the Tarmed changes proposed by Federal Councillor Alain Berset. But three aspects of the proposal should be improved:

As before, there is still no item that can be used by specially qualified carers and MPAs (nurses) to charge their services provided independently under the supervision of a medical doctor, such as taking care of diabetes patients.

Secondly, a fixed supplement is needed for GPs making house calls. At present, it is not financially interesting for doctors to make house calls. Any service technician on a home visit earns considerably more than the doctor.

And thirdly, we do not agree with the limitation of the item “Service provided in the absence of the patient” in the statement. General practitioners increasingly need to organise and coordinate the services provided by different parties, i.e. tasks that are mostly done in the absence of the patient. These services are particularly important for chronically ill and polymorbid patients.

Tariff intervention in this form: no

The Federal Council presented its proposals for changes to the tariff structure in spring. It hopes to save CHF 700 million. To no avail, because this second intervention also does not correct the misplaced incentives for volume expansion.

The undeniably old-fashioned nomenclature makes it difficult to charge current services and requires a new interpretation of existing items. The planned tariff reductions can be compensated by supplementary services and by optimising the capture of services.

The tariff intervention is neither appropriate nor justified in business terms. This is confirmed by the one-sided reductions for MR and CT scans, while the tariffs for ultrasound – which accounts for the highest volume of costs in this field – are hardly or not at all reduced. It is also a breach of the Federal Health Insurance Act (KVG) if medical services relating to CT and MR scans are no longer paid.

It would make better sense to refrain from government intervention and try and find solutions based on tariff partnerships for a modern and sustainable tariff model for outpatient medical services.

Even though the tariff intervention in its current form has to be rejected, the proposal still contains some good ideas. The tariff intervention poses a challenge to all of us.

Where is the tariff partnership going?

Wolfram Strüwe, Head of Health Policy at Helsana

Money is naturally a difficult topic for the healthcare system. Insurers and doctors have long been aware of this fact. But what is new is that insurers no longer agree on the sensible distribution of money among themselves, i.e. on risk compensation. Medical doctors are now facing the same destiny with the tariff intervention. The intervention is coming as sure as day follows night. The question is just whether everybody will see reason. If not, it spells the end of uniform tariff solutions. Would that be bad? No, because we know that the KVG also permits solutions negotiated by only some of the partners. Those who cannot agree will actually be choosing the government's solution.